Carr (1988) — Subtalar distraction bone block fusion for late complications of os calcis fractures

Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

·Foot Ankle·1988·250 citations·Foot & Ankle

Carr, Hansen, and Benirschke describe a salvage procedure — subtalar distraction bone block fusion — for painful calcaneus malunions. The study asks whether restoring lost heel height via a tricortical iliac crest graft can correct the talocalcaneal deformity, relieve tibiotalar neck impingement, and improve function in patients who have failed conservative management.

Study Snapshot

Design

Retrospective case series

Objective

Whether subtalar distraction bone block fusion corrects late calcaneus fracture complications

Outcome(s)

Satisfactory clinical outcome at final follow-up

Subjects

16 feet, late calcaneus fracture complications

Subtalar distraction bone block fusion with rigid screw fixation

Inclusion

Late complications of calcaneus fractures
Pain, shoe wear difficulties, or foot deformity

Follow-up

Mean 19 months

Key Findings

Of 8 patients with greater than 1 year of follow-up, 4 were pain-free, 2 had mild pain with good function, and 2 had persistent pain with impairment — a 75% satisfactory rate in the evaluable cohort
Radiographic correction approached but did not fully reach normal: lateral talocalcaneal angle rose from 14° to 24° (normal 25°–45°), and talar declination improved from 21° to 36°, reflecting meaningful but incomplete re-pitching of the talus
Average hindfoot height gain was 1.0 cm (range 0.5–1.9 cm), achieved with tricortical iliac crest grafts sized up to 2.5 cm — confirming that substantial structural restoration is achievable with interposition grafting
Two-screw fixation prevented rotatory height loss; single-screw and unfixed constructs lost correction postoperatively, making rigid two-screw constructs the minimum acceptable construct
Wound complications occurred in 5 of 16 feet (31%), all superficial; the straight posterolateral incision proved less prone to skin slough than the earlier J-incision, with zero deep infections across the series

Clinical Relevance

When you see a patient with ankle pain and limited dorsiflexion after a calcaneus fracture, check the lateral talocalcaneal and talar declination angles — a horizontalized talus causing tibiotalar neck impingement is a correctable deformity, not just arthritis, and these patients may benefit from distraction bone block fusion rather than in situ subtalar fusion alone.

Supplemental

Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

Carr, Benirschke, et al.·Foot Ankle·1988·250 citations·Foot & Ankle

Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

Study Snapshot

Key Findings

Clinical Relevance

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Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

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Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

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Subtalar Distraction Bone Block Fusion for Late Complications of Os Calcis Fractures

Study Snapshot

Key Findings

Clinical Relevance

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